Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 2014
ReviewNuking the radiation: minimizing radiation exposure in the evaluation of pediatric blunt trauma.
Our objective is to highlight recent literature investigating low-radiation diagnostic strategies in the evaluation of pediatric trauma. ⋯ More research is needed in development of pediatric-specific clinical decision rules and risk stratification and in testing low-radiation diagnostic modalities in the pediatric trauma population.
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Curr. Opin. Pediatr. · Jun 2014
ReviewAdvances in point-of-care ultrasound in pediatric emergency medicine.
Point-of-care ultrasound (POCUS) has become an integral part of emergency medicine practice. Research evaluating POCUS in the care of pediatric patients has improved the understanding of its potential role in clinical care. ⋯ Key applications in PEM have been investigated in the recent publications. Further exploration of the ability to integrate ultrasound into routine practice will require larger-scale studies and continued growth of education in the field. The use of ultrasound in clinical practice has the potential to improve safety and efficiency of care in the pediatric emergency department.
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Curr. Opin. Pediatr. · Jun 2014
ReviewA paradigm shift in the treatment of extreme prematurity: the artificial placenta.
Extremely low gestational age newborns (ELGANs), born at less than 28 weeks' estimated gestational age, suffer the greatest consequences of prematurity. There have been significant advances in their care over the last several decades, but the prospects for major advances within traditional treatment modalities appear limited. An artificial placenta using extracorporeal life support (ECLS) has been investigated in the laboratory as a new advance in the treatment of ELGANs. We review the concept of an artificial placenta, the purported benefits, and the most recent research efforts in this area. ⋯ ELGANs suffer the greatest morbidity and mortality of prematurity, and are poised to benefit from a paradigm shift in the treatment. Although challenges remain, the artificial placenta is feasible. An artificial placenta would not only protect ELGANs from the complications of mechanical ventilation, but also support their development until a stage of greater maturity, preparing them for a life free of the sequelae of prematurity.
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To review the current literature on venous thromboembolism (VTE) in critically ill children. ⋯ Pediatric critical care practitioners should be cognizant of the importance of VTE in critically ill children to allow early identification and treatment. Adequately powered clinical trials are critically needed to generate evidence that will guide the treatment and prevention of thromboembolism in critically ill children. Risk assessment tools that incorporate biomarkers may improve our ability to predict the occurrence of thromboembolism in critically ill children.
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To summarize our current understanding of the pathophysiology, diagnosis, and management of acute traumatic coagulopathy in children. ⋯ Prospective studies are needed to determine how to best diagnose and manage acute traumatic coagulopathy in children.